332 Predictors and prognostic value of contrast-induced nephropathy in patients undergoing primary angioplasty

Abstract

Contrast-induced nephropathy (CIN) after coronariography has been associated to increased morbidity and mortality. Patients submitted to primary angioplasty seem to be at higher risk for CIN development, owing in part to hemodynamic status. We sought to determine the prevalence, predictors and prognostic value of CIN occurrence after primary angioplasty. A total of 141 patients consecutively submitted to primary angioplasty and admitted to our coronary unit were reviewed. CIN was defined as impairment of renal function occurring within 48 hours after administration of contrast media and manifested by an absolute increase in the serum creatinine level of at least 0.5 mg/dl or by a relative increase of at least 25% over the baseline value (in the absence of another cause). The primary end points were in-hospital and six-month mortality. CIN developed in 18.4% of the patients (n = 26). Patients with CIN were older (68 ± 13 vs 61 ± 13 years; p < 0.05) and more often had diabetes mellitus (38.5% vs 15.7%; p < 0.05). Although statistical significance was not reached, there was a trend for higher prevalence of hypertension (61.5% vs 42.6%; p = 0.09), female gender (30.8% vs 18.3%; p = 0.18) and Killip class higher than one at admission (26.9% vs 16.3%; p = 0.1) among patients with CIN. Patients with CIN had an higher mean time from symptoms to reperfusion (304 ± 192 vs 397 ± 206 minutes; p < 0.04). By multivariate analysis, independent correlates of CIN were older age (OR = 1.04; 95%CI = 1.01 − 1.08) and diabetes mellitus (OR = 2.99; 95%CI = 1.08 − 8.3). Patients with CIN had higher in-hospital (19.2% vs 0.9%; p < 0.05) and 6-month mortality (28.6% vs 4.9%; p < 0.05). CIN was a frequent complication of primary angioplasty (18.4% of the patients). Independent predictors of CIN after primary angioplasty were older age and diabetes mellitus. Patients with CIN had a worse prognosis, both during in-hospital stay and at 6 months.